Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network. Breast Cancer Res Treat 2019 Jun;175(3):675-689
Date
03/11/2019Pubmed ID
30852760Pubmed Central ID
PMC6534523DOI
10.1007/s10549-019-05184-1Scopus ID
2-s2.0-85062719202 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
PURPOSE: Chronic upper extremity disability (UED) is common after breast cancer treatment but under-identified and under-treated. Although UED has been linked to quality of life (QoL), the role of UED as mediator between contemporary treatment practices and QoL has not been quantified. This investigation describes UED in a contemporary sample of breast cancer patients and examines its relationship with personal and treatment factors and QoL.
METHODS: Eight hundred and thirty-three women diagnosed at eight medical institutions during 2013-2014 with microscopically confirmed ductal carcinoma in situ or invasive stage I-III breast cancer were surveyed an average of 22 months after diagnosis. UED was measured with a modified QuickDASH and QoL with the FACT-B. The questionnaire also collected treatments, sociodemographic information, comorbidity, body mass index, and a 3-item health literacy screener.
RESULTS: Women who received post-mastectomy radiation and chemotherapy experienced significantly worse UED and QoL. Women who had lower income, lower health literacy and prior diabetes, arthritis or shoulder diagnoses had worse UED. Patients with worse UED reported significantly worse QoL. Income and health literacy were independently associated with QoL after adjustment for UED but treatment and prior conditions were not, indicating mediation by UED. UED mediated 52-79% of the effect of mastectomy-based treatments on QoL as compared with unilateral mastectomy without radiation. UED and QoL did not differ by type of axillary surgery or post-mastectomy reconstruction.
CONCLUSIONS: A large portion of treatment effect on QoL is mediated by UED. Rehabilitation practices that prevent and alleviate UED are likely to improve QoL for breast cancer survivors.
Author List
Chrischilles EA, Riley D, Letuchy E, Koehler L, Neuner J, Jernigan C, Gryzlak B, Segal N, McDowell B, Smith B, Sugg SL, Armer JM, Lizarraga IMAuthor
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Arm Injuries
Breast Neoplasms
Combined Modality Therapy
Drug Therapy
Female
Humans
Mastectomy
Middle Aged
Neoplasm Invasiveness
Quality of Life
Radiotherapy
Shoulder Injuries
Surveys and Questionnaires
Upper Extremity